Organization
AEGIS PHYSICAL THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN DOMENECH MPT (OWNER/PRESIDENT)
(760) 322-5090
Entity
Organization
Contact information
Practice address
27620 LANDAU BLVD STE 3, CATHEDRAL CITY, CA 92234-5540
(760) 322-5090
(760) 322-9175
Mailing address
27620 LANDAU BLVD STE 3, CATHEDRAL CITY, CA 92234-5540
(760) 322-5090
(760) 322-9175
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ64403Z
BLUE SHIELD GROUP
CA
Enumeration date
07/23/2007
Last updated
08/29/2016
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